This study evaluated the effects of intensive lifestyle modification (ILM) incorporating calorie-carbohydrate restriction (CCR) with or without time-restricted feeding (IFCCR) on psychological health in adults with type 2 diabetes (T2D). In a 24-week randomized controlled trial, 120 adults with T2D were allocated to CCR (n = 40), IFCCR (n = 40), or a control group (n = 40). Both intervention arms followed an energy-restricted diet (1000–1200 kcal/day), received behavioral support, and performed ≥ 150 min/week of physical activity. The IFCCR group additionally restricted eating to an 8-hour daily window. Primary and secondary outcomes were eating disorder psychopathology (EDE-Q scale) and diabetes-related distress (PAID scale), respectively. Both CCR and IFCCR significantly reduced diabetes-related distress compared to the control (CCR: β = -1.80, p = 0.007; IFCCR: β = -1.78, p = 0.01). EDE-Q scores also improved significantly. Improvements were observed across EDE-Q subscales, particularly in weight and shape concern. After adjustment for changes in weight and HbA1c, reductions in PAID became non-significant, while improvements in several EDE-Q domains, particularly in the IFCCR group, remained significant. IFCCR showed numerically greater reductions than CCR, though differences were not statistically significant. The control group demonstrated minimal changes. Intensive lifestyle modification incorporating CCR or IFCCR improved eating disorder psychopathology, whereas reductions in diabetes-related distress appear largely related to metabolic changes. These findings support the integration of structured dietary and behavioral interventions into diabetes care. This trial was registered in Iranian Registry of Clinical Trials (IRCT), IRCT20230917059447N1 (https//irct.behdasht.gov.ir/trial/72666).
Mohammadpour et al. (Tue,) studied this question.